A Real Pain In The Butt - Page #1

Author: Brooke Schutte, MD
Co Author #1: Krystle Farmer, MD

Patient Presentation:
13 year old M presented with left posterior hip pain for one month after falling directly on his left side in a football game.

The patient was running and fell directly onto his left side. He was not tackeled and nobody landed on him.
The patient was able to ambulate after the injury, but developed soreness and increasing pain three days post injury where he presented to an urgent care clinic.

A plain radiograph demonstrated a possible coccyx fracture. He was treated conservatively with rest, non steroidal anti-inflammatory medication, and a donut seat cushion.

Two-weeks after the injury he was diagnosed with right foot cellulitis. There was no apparent interval event that caused this. He was given a 5 day course of an antibiotic (he did not remember which).

One-month post-injury he reported severe daily "squeezing" pain in the left hip and difficulty with ambulation.

His past medical history was otherwise unremarkable.

Physical Exam:
BP: 119/80; HR: 91; BMI: 19.7
Healthy, non-toxic.

Left Hip Exam: No erythema, ecchymosis, edema, scars. Sensation intact. Femoral pulse 2+
There was tenderness to palpation at the inferior sacroiliac joint and the piriformis muscle.
Active range of motion was significantly limited due to pain and weakness. Passive-range of motion was almost full. There was limited external rotation.
Strength: 3/5 Hip abduction; 2/5 Hip flexion and extension; 4/5 Hip Adduction
Faber Test: positive
No leg length discrepancy, no hip height discrepancy.

Right Hip Exam: normal

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